Genital Lesions

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of genital lesions

Location is on ‍pubispenisscrotumvulvavaginaperineumanus

Symptoms include:

‍painful ulcers

‍blisters

‍sores

‍burning

‍itching

‍tingling

‍dysuria

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍urethral discharge

‍swollen lymph nodes in the groin

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍muscle aches



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍unprotected sex

‍multiple sexual partners

no history of: ‍genital herpes, ‍sexually transmitted infections, ‍HIV, ‍immunodeficiency

HPV vaccination status: ‍up-to-dateincompleteunvaccinated





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Genital rash ‍likelysuspectedpossible

DDx: genital herpes, genital warts (HPV), syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, yeast infection, scabies, folliculitis, skin tags, hemorrhoids, bartholinitis, contact dermatitis, psoriasis, lichen planus, lichen sclerosus, squamous cell carcinoma





PLAN:

Investigations:

- STI testing for chlamydia and gonorrhea

- HSV swab

- Blood work: ‍HIV, ‍syphilis, ‍hepatitis B, ‍hepatitis C

- HPV testing

- Biopsy

Treatments:

- ‍Topical treatments

- ‍Physical treatments

- ‍Intralesional treatments

- ‍Antivirals

- Use of condoms until lesions are completely treated (but may still be transmitted)

- Counseling on safe sex practices and disclosure to partners

- ‍HPV vaccine

Further care:

- Referral to dermatologist

- Referral to gynecologist

- Referral to urologist

- Follow-up in ‍ ‍weeksmonths

- Return if lesions do not resolve or if new lesions develop